Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $92.64 / $115.62 / $148.85	Facility	26	$92.64	$115.62	$148.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $242.07 / $329.32 / $524.96	Professional		$242.07	$329.32	$524.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $92.64 / $115.80 / $256.68	Professional	26	$92.64	$115.80	$256.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $149.43 / $212.09 / $380.16	Professional	TC	$149.43	$212.09	$380.16
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $270.63 / $309.29 / $381.73	Professional		$270.63	$309.29	$381.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $85.05 / $108.56 / $207.32	Professional	26	$85.05	$108.56	$207.32
BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.44 / $225.67 / $350.48	Professional		$91.44	$225.67	$350.48
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $384.20 / $521.91 / $773.22	Professional		$384.20	$521.91	$773.22
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $105.23 / $112.44 / $234.07	Professional	26	$105.23	$112.44	$234.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.28 / $128.28 / $128.28	Facility	26	$128.28	$128.28	$128.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $301.45 / $490.49 / $935.72	Professional		$301.45	$490.49	$935.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.06 / $122.24 / $232.50	Professional	26	$81.06	$122.24	$232.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $216.47 / $373.58 / $756.01	Professional	TC	$216.47	$373.58	$756.01
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $815.92 / $1,024.72 / $1,048.24	Facility	26	$815.92	$1,024.72	$1,048.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $4,801.00 / $4,801.00 / $4,801.00	Professional		$4,801.00	$4,801.00	$4,801.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1,632.94 / $1,632.94 / $1,632.94	Professional	26	$1,632.94	$1,632.94	$1,632.94
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,601.00 / $3,601.00 / $3,601.00	Professional	TC	$3,601.00	$3,601.00	$3,601.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $272.02 / $606.98 / $976.30	Professional		$272.02	$606.98	$976.30
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $140.44 / $178.27 / $432.16	Professional	26	$140.44	$178.27	$432.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $385.61 / $489.42 / $1,186.48	Professional	TC	$385.61	$489.42	$1,186.48
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $135.69 / $433.26 / $851.42	Professional		$135.69	$433.26	$851.42
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $128.28 / $128.28 / $128.28	Facility	26	$128.28	$128.28	$128.28
Providence Facility/Professional Professional Modifier Low / Median / High Price $301.52 / $537.70 / $1,130.55	Professional		$301.52	$537.70	$1,130.55
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $79.73 / $118.36 / $224.07	Professional	26	$79.73	$118.36	$224.07
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $201.64 / $356.48 / $742.16	Professional	TC	$201.64	$356.48	$742.16
United Facility/Professional Professional Modifier Low / Median / High Price $360.61 / $497.50 / $858.78	Professional		$360.61	$497.50	$858.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $97.06 / $120.90 / $205.53	Professional	26	$97.06	$120.90	$205.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $260.52 / $363.84 / $655.76	Professional	TC	$260.52	$363.84	$655.76
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $244.04 / $274.43 / $388.29	Professional		$244.04	$274.43	$388.29
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $92.21 / $106.32 / $146.56	Professional	26	$92.21	$106.32	$146.56
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $151.84 / $177.49 / $1,100.00	Professional	TC	$151.84	$177.49	$1,100.00